Bedsores (Pressure Ulcers) Symptoms and Treatments

A pressure sore, also known as a bed sore or pressure ulcer, is an injury to the skin that occurs when blood flow to the area is disrupted due to sitting or lying in one position for a long time.  Bedsores are common. In the United States, it's believed that around 2.5 million people each year will develop bed sores.

The early stages of a pressure sore may include discomfort and changes in skin color and temperature. Recognizing them quickly—and making adjustments to prevent them from worsening—can help you avoid pain and complications.

This article discusses pressure sores, how you can prevent them, and what to do if you spot the early signs of a developing sore.

What Are the Symptoms of Bedsores?

The beginning signs of a pressure sore include:

• Red skin in light-skinned people or a blue or purple tint in darker-skinned people
• Skin that’s either abnormally warm or cool to the touch
  
• Skin that doesn't pass the blanching test (pressing on the skin to see if redness or discoloration disappears)
• Pain, tingling, or itching on any part of the body (even if it’s minor)
  

Stages of Bedsores

Pressure sores are categorized by stage, from mild to severe. The four stages are as follows:

• Grade I pressure sores look swollen and feel warm. There is no break in the skin at this stage. On pale skin, the developing sore will look red; on darker skin, it may look purple or blue. When you put pressure on the sore it will not blanch (become lighter in color). Grade I sores may hurt or itch.
• Grade II pressure sores will have some area of skin damage or skin loss on the first or second layer of skin. They may look like an open sore, a bad scrape, a blister, or a shallow crater. The person with the sore will begin to feel significant pain at this stage.
• Grade III pressure sores are much deeper, affecting tissue but not muscle or bone. Grade III pressures will look like a deep crater.
• Grade IV pressure sores are the most severe. The skin and tissue will show extensive damage that may also affect the muscle or bone. The tissue in and around the sore is beginning to die. A sore that gets to this stage puts the person at significantly increased chances of life-threatening infections.

Pressure sores can appear on any part of the skin that has prolonged contact with an object like a bed or wheelchair. They usually appear on bony areas, including the hip bone, tail bone, spine, shoulder blades, elbows, back of the head, knees, and heels.

Risk Factors For Bedsores

Some people are more likely to develop bed sores than others. Some of the things that increase the risk include:

• Immobility: People who are confined to their beds or a wheelchair are more likely to develop bedsores.
• Age: People older than 70 are more likely to develop bed sores.
• Dry skin: Very dry skin is more vulnerable to becoming damaged.
• Malnutrition: Poor nutrition can affect the ability to heal and can make skin more prone to damage and infection.
• Dehydration: People who don't drink enough fluids are more susceptible to getting bedsores.
• Low body weight: People who are extremely thin may be more likely to get bedsores on bony parts of the body.
• Circulation problems: A person who has a medical condition like diabetes or vascular disease is more likely to develop bedsores.
• Incontinence: Skin that is constantly damp or dirty is more vulnerable to bed sores and infections.
• Neurological conditions: Certain conditions can make you unable to sense the pain or discomfort of a developing bedsore.
  

What Are the Causes of Bedsores?

Pressure sores develop in areas where your weight is pressing against a surface. If that pressure lasts for more than two or three hours and your blood can’t reach the area, the skin, and underlying tissues become damaged because of the lack of oxygen and nutrients.

Wearing a cast, splint, or prosthetic device can also lead to pressure sores. They are also more likely to form in areas where your skin is wet from a fluid like urine or sweat.

Pressure sores are more likely to develop when you're elderly; as you age, your skin becomes thinner and more easily damaged. You’re also more likely to get pressure sores if you have mobility issues, are unable to switch positions, suffer from malnutrition, or have a loss of sensation in your skin.

How Are Bedsores Diagnosed?

Pressure sore diagnosis begins with a skin examination. Your healthcare provider will ask you questions about when the sore appeared and whether or not it hurts. They will also want to know how often you change position and whether you have had bed sores in the past.

Your healthcare provider will be able to assess whether your sore is a pressure sore and if so, what stage it is in. If they think the sore might be infected, they may also:

• Take a blood sample for a blood test
• Biopsy the sore (take a sample of the tissue)
• Order an X-ray or other imaging test to determine the extent of the sore

What Are the Complications of Bedsores?

Untreated bed sores can cause serious complications, such as:

• Abscess: Bacteria can get into an open bed sore and cause an abscess, or a painful collection of pus.
• Cellulitis: This is an inflammation of body tissue caused by a bacterial infection.
• Osteomyelitis: When bacteria reach the bones it can cause painful swelling of the bone marrow.
• Septic arthritis: This is an infection of the joints that can cause damage to cartilage and impact joint function.
• Sepsis: An infected bedsore may progress to sepsis, a whole-body response to infection that can be life-threatening.
• Meningitis or endocarditis: An infected bedsore can lead to much more serious infections of the brain or heart.
• Amputation: Very severe bed sores that become infected may lead to amputation of the affected limb.
  

How Are Bedsores Treated?

The care you need depends on how advanced your bed sore is. Always check with your healthcare provider to make sure that you’re receiving the right treatment.

If your practitioner diagnoses you with an early stage of pressure sores, they may recommend the following:

• Relieve pressure on the area: If you’re in a wheelchair, change positions every 15 minutes by leaning forward and side-to-side. If you’re in bed, make sure you’re moving to a new position every two hours. Use pillows or other supports to help keep you comfortable in different positions.
• Keep skin clean and dry: If you see signs of the start of a pressure sore, wash it with mild soap and water. Gently pat it dry or allow it to air dry completely.
• Rinse it with saline: For an open sore, your provider may recommend cleaning with a saline rinse. Gently pat the area dry. Do not rub it.
• Cover the sore, if needed: Ask your healthcare provider if your sore should be kept covered. In some cases, a medicated gauze or other special dressings is used to improve healing.
• Ensure adequate nutrition: It is unclear whether changes to the diet can help someone with bedsores, however, there is some evidence that a higher protein diet may contribute to an improved healing process. Make sure the person gets adequate nutrition including protein and ensure they're staying well-hydrated.
• Adjust the bedding, if indicated: Make sure your bedding is soft and non-abrasive; choose satin-textured sheets and avoid blankets with rough surfaces. It may also help to add an egg-crate style mattress topper, which can reduce pressure wherever the body contacts the mattress. Other types of special mattresses are available to help prevent bedsores; talk to your healthcare provider about which ones might work best for you or your loved one. 

More advanced sores will take a longer time to heal and will need to be treated by a healthcare provider. Treatments may include:

• Antibiotics and other medicine: If pressure sores show signs of infection, you may be given oral or topical antibiotics or other medications.
• Removing dead tissue (debridement): This procedure removes dead tissue using a scalpel, chemical solution, whirlpool bath, or biosurgery.
• Negative pressure wound therapy: This is a method of drawing out fluid and infection from a wound to improve healing,
• Skin grafts: After removing damaged tissue, healthy skin is removed from another part of the body and transplanted over the pressure sore.

How Are Bedsores Prevented?

Bedsores can be prevented by ensuring the person changes position frequently, at least every two hours. Other things you can do to prevent bedsores or keep them from worsening include:

• Checking the skin regularly for early signs of bed sores
• Remaining active, even if this means doing easy physical exercises while in bed or sitting in a chair
• Keeping the skin clean and dry
• Avoiding cigarette smoke
• Eating well and staying hydrated
  

Summary

Pressure sores can develop if you spend too much time sitting or lying in the same position. Pressure sores are common in people who are immobile due to an illness or physical disability.

If you're at risk for pressure sores, check your skin daily for early signs and make sure to change position at least once every two hours. If you're not sure how to spot the early signs of pressure sores, don't hesitate to call your healthcare provider. They can help you to identify pressure sores before they cause any complications.